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<br /> /1~t77--/.31 <br />ACORD.. CERTIFICATE OF LIABILITY INSURANCE CSR PF f DATE (MMIDDNYYY) <br />SYMCO -1 05/17/07 <br />PRODUCER THIS CERTIFICATE 15 ISSUED AS A MATTER OF INFORMATION <br /> ONLY AND CONFERS NO RIGHTS UPON THE CERTlFICATC <br />Burnette Insurance Agency,Inc. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br />3447 Lawrenceville Suwanee Rd. ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br />Suwanee GA 30024-2402 <br />Phone: 770-339-8888 Fax:770-339-1442 'INSURERS AFFORDING COVERAGE NAIC# <br />INSURED INSURER A: zurich u.s. Insurance <br /> A-2008-152 INSURER B: The Hartford <br /> s~co Grou~ Inc. INSURER C: <br /> 1 5 Satell te Blvd. Suite 5 INSURER 0: <br /> Suwanee GA 30024 <br /> INSURER E: <br /> <br />COVERAGES <br /> <br />THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. N01WITHSTANDING <br />ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR <br />MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH <br />POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />LTR NSRt TYPE OF INSURANCE POLICY NUMBER DATE MM/D~ OAk IMwbiiiYV'i' LIMITS <br /> ~NERAL UABILiTY EACH OCCURRENCE $1,000,000 <br />A X COMMERCIAL GENERAL LIABILITY 040972979 07/31/07 07/31/08 PREMISES (Ea occurencel $300,000 <br /> f-- ~ CLAIMS MADE [!] OCCUR MED EXP (Anyone person) $10,000 <br /> f-- PERSONAL & ADV INJURY $1,000,000 <br /> f-- GENERAL AGGREGATE $2,000,000 <br /> !il'L AGGREnE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $2,000,000 <br /> X POLICY ~~8r n LOC <br /> ~OMOBILE LIABILITY COMBINED SINGLE LIMIT $1,000,000 <br />A ~ At-N AUTO 040972979 07/31/07 07/31/08 (Ea accident) <br /> f-- ALL OWNED AUTOS BODILY INJURY <br /> $ <br /> SCHEDULED AUTOS (Par person) <br /> i-- <br /> ~ HIRED AUTOS BODILY INJURY <br /> $ <br /> - ~ ~ NON-OWNED AUTOS (Par accident) <br /> . <br /> i-- PROPERTY DAMAGE $ <br /> (Per accident) <br /> RRAGE LIABILITY AUTO ONLY - EA ACCIDENT $ <br /> ANY AUTO NOT APPLICABLE OTHER THAN EA ACC $ <br /> AUTO ONLY: AGG $ <br /> EXCESSlUMBRELLA LIABILITY EACH OCCURRENCE $1,000,000 <br />A I!J OCCUR D CLAIMS MADE 040972979 07/31/07 07/31/08 AGGREGATE $1,000,000 <br /> $ <br /> ~ DEDUCTIBLE $ <br /> X RETENTION $0 $ <br /> WORKERS COMPENSATION AND X I TORY LIMITS I IU~tt <br />'B EMPLOYERS' LIABILITY 20WBPK0442 11/28/06 11/28/07 $ 100,000 <br />ANY PROPRIETORlPARTNER/EXECUTIVE E.L EACH ACCIDENT <br /> OFFICER/MEMBER EXCLUDED? E.L DISEASE - EA EMPLOYEE $100,000 <br /> ~~~~I~r~WO'V~~~~NS below E.L. DISEASE - POLICY LIMIT $500,000 <br /> OTHER <br />A BUSINESS 040972979 07/31/07 07/31/08 BUSINESS $2,334,000 <br /> PROPERTY lUIPLACBMBlft' COST BASXS PROPERTY $500 DED <br />DESCRIPTION OF OPERATIONS I LOCATIONS f VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS !'\.,.p l' R 0 V 13 <br />Certificate holder is listed as additional insured as per contractual 1) AlS TO FORM <br />obligation./Faxed 714-647-5406.SEE REVISED WC INFORMATION. ~ <br /> ~ - ./ ~/ <br /> __ /ir7... _~,. <br /> Laura Stitt Sh - <br /> A.ssistant Citv A .~~ <br />CERTIFICATE HOLDER CANCELLATION / 'VJ, <br /> SANTAAN SHOULO ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATlO~ <br /> DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL ~ DAYS WRITTEN <br /> City of Santa Ana NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL <br /> Linda Kelley IMPOSE NO OBLIGATION OR LIABILITY OF ANY KI,~D UPON THE INSURER,ITS AGENTS OR <br /> 20 Civic Center Plaza <br /> Santa Ana CA 92702 REPRESENTATIVES. , "- <br /> A~!ii-ES~~~, _~ , <br /> , <br /> <br />ACORD 25 (2001/08) <br /> <br />@ACORDCORPORATION 1988 <br />